Updated: 10/6/2016

Deltoid Rupture

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Introduction
  •  Deltoid ruptures are usually strains or partial tears
    • complete ruptures are rare
  • Epidemiology
    • incidence
      • rare
    • risk factors
      • repeated corticosteroid injections about the shoulder
      • rotator cuff tear
      • trauma
  • Pathophysiology
    • mechanism
      • secondary to repeated corticosteroid injections about the shoulder
      • massive rotator cuff tear
        • proximal migration of the humeral head leads to compression/abrasion of undersurface of deltoid by greater tuberosity
      • iatrogenic injury 
        • during open rotator cuff repair
      • trauma
        • sudden deltoid contracture
        • shoulder contusion
  • Associated conditions
    • rotator cuff tear
Anatomy
  • Deltoid anatomy 
Presentation
  • Symptoms
    • shoulder pain
  • Physical exam
    • inspection
      • depression over deltoid   
      • soft tissue mass distal to depression (contracted muscle)
Imaging
  • Radiographs
    • recommended views
      • shoulder radiographs
    • findings
      • associated with cuff tear arthropathy
      • proximal humeral head migration
  • Ultrasound
    • indications
      • noninvasive method of detection
    • findings  
      • shows deltoid gap with intact surrounding fibers
  • MRI
    • indications
      • differentiate partial vs complete deltoid tears
      • associated rotator cuff pathology
    • findings  
      • deltoid defect
      • associated rotator cuff tear
Treatment
  • Nonoperative
    • observation only
      • indications
        • chronic injuries in elderly patients
  • Operative
    • early surgical repair
      • indications
        • complete rupture
    • deltoplasty with mobilization and anterior transfer of the middle third of the deltoid
      • indications
        • iatragenic injury during rotator cuff repair
 

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